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Due to consistently low birth rates and a higher life expectancy, countries within the European Union are transitioning to a much older population structure.1 The average number of older persons in the total population will increase significantly in the coming decade, as a large proportion of the post-war, baby-boom generation will reach retirement. Compared with generations prior, the ‘baby boomers’ were the most physically fit generation; however, they also grew up when smoking rates and exposure to secondhand smoke were at their peak.2

Tobacco use is a risk factor for six of the eight leading causes of death in the world including respiratory and cardiovascular diseases, stroke and cancer.2 Of these diseases, chronic obstructive pulmonary disease (COPD) is a major growing cause of morbidity and mortality3 with smoking and secondhand smoke exposure being the most important causative factors of the disease.3 In the European Union, the total direct costs of COPD account for 56% (€38.6 billion) of the total healthcare budget. As there is growing evidence that up to 50% of smokers will eventually develop COPD,4–6 the ageing ‘baby-boomer’ population will therefore have a significant effect on future healthcare demands.7

COPD is characterised by irreversible chronic airflow limitation that is caused by emphysematous destruction of lung elastic tissue and obstruction in the small airways due to occlusion of their lumen by inflammatory mucus exudates, narrowing and obliteration. In COPD, the airflow limitation measured by reduced forced expiratory volume in 1 s, progresses very slowly over time—potentially due to the high redundancy of small airway generations.8 9 Therefore, despite symptoms such as cough and phlegm being associated with susceptible smokers aged 20–44 years who will develop COPD, loss of lung function is …

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